Surgical vs. conservative treatment for hip osteoporotic fracture in maintenance hemodialysis patients: a retrospective analysis

Abstract

Background: HSip Osteoporotic fractures are common complications with high mortality in patients undergoing maintenance hemodialysis (MHD). It remains unclear whether surgical or conservative should be adopted for hip fractures in MHD patients.

Methods: A retrospective analysis was conducted in Tianjin Hospital of Tianjin University from August 2019 to August 2023. A total of 43 MHD patients with hip fracture were included, with 30 cases in the surgical group and 13 cases in the conservative group. The differences in cumulative survival rates, time to first ambulation, Harris score, Barthel index, and incidence of complications were compared.

Results: The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). In the surgical treatment group, the first ambulation time was reduced to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days, P < 0.001). The Harris score at 1 month (61.50 ± 4.10) and the Barthel index at 3 months (95, 11.25) were also significantly higher (P < 0.001). Furthermore, the surgical group had a significantly lower overall incidence of complications (60.00 vs. 92.31%, P = 0.034). The risk of death and complications of surgical treatment was only 23.0 and 32.4% of conservative treatment in MHD patients with hip fracture.

Conclusion: Surgical treatment is effective and safe and should be the first choice for hip fracture in MHD patients.

Keywords: hip arthroplasty; hip fracture; maintenance hemodialysis; osteoporosis; surgical treatment.

Figure 1

Comparison of the differences in survival outcomes between different treatment groups. (A) The mortality rates after fracture. The mortality rates after fracture between the different treatment groups are shown in the bar chart. The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). (B) Kaplan-Meier Survival Curves Analysis of conservative treatment and surgical treatment in MHD patients with hip osteoporotic fracture. The Kaplan-Meier method was used to estimate overall survival, and we conclude that: compared with conservative treatment, surgical treatment can significantly lower mortality rates, thereby prolonging survival.

Figure 2

Hip joint functional recovery between different treatment groups. (A) Comparison of the time to first ambulation after fracture. Mann-Whitney U-test indicated that surgical treatment effectively shortened the first ambulation to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days). (B) Comparison of Harris score and Barthel index after fracture. The Harris score at one month after the fracture and the Barthel index at three months after the fracture were performed to reflect early joint function recovery and long-term daily activity capability, respectively. The above scores in the surgical treatment group were significantly higher than those in the conservative treatment group, indicating that appropriate surgical treatment did accelerate the recovery of joint function in MHD parents.

Figure 3

Comparison of the incidence of complications after hip fractures between different treatment groups. The incidence of complications after fracture in patients of different treatment groups is shown in the bar chart. According to statistics, the incidence of thrombotic complications (6.67%, P = 0.036) and overall clinical complications (60.00%, P = 0.034) in the follow-up period were significantly lower in the surgical treatment group with statistically significant differences.